CARDIOVASCULAR DRUGS!!!!! - PowerPoint PPT Presentation

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CARDIOVASCULAR DRUGS!!!!!

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CARDIOVASCULAR DRUGS!!!!! Adenosine MOA Increased K efflux: hyperpolarization. Drug of choice for which conditions? AV nodal arrhythmias. Short or long acting? – PowerPoint PPT presentation

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Title: CARDIOVASCULAR DRUGS!!!!!


1
CARDIOVASCULAR DRUGS!!!!!
2
Methyldopa
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Sedation, positive coombs test

3
Reserpine
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Sedation, depression, nasal stuffiness, diarrhea

4
Hydrochlorothiazide
  • Use?
  • SE?
  • Diuretic, HTN
  • Hypo-K, Hyperlipidemia, hyperuricemia, lassitude,
    Hyper-Ca, Hyperglycemia

5
Clonidine
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Dry mouth, sedation, severe rebound HTN

6
Guanethidine
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Orthostatic exercise hypotension, diarrhea,
    sexual dysfxn ?

7
Nitroglycerin, Isosorbide Dinitrate
  • Use?
  • MOA?
  • Decreased Preload or Afterload?
  • Toxicity
  • Vasodilatorangina, pulm edema,
    aphrodisiac/erection enhancer ?
  • Releases NO from smooth muscle increased cGMP ?
    relaxation. Veinsgt Arteries
  • Which does Arteries gt Veins?
  • HYDRALAZINE
  • PRELOAD
  • Tachycardia, Flushing, HA, hypotension, Monday
    Diseasedecreased tolerance over weekend ? tach,
    dizziness and HA on reexposure

8
Prazosin
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Orthostatic hypotension with 1st dose, dizziness,
    headache

9
Diazoxide
  • Use?
  • SE?
  • Vasodilator, HTN
  • Hyperglycemia, decreased insulin release,
    hypotension

10
Beta blockers
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Impotence ?, asthma, cardiovascular effects
    (bradycardia, CHF, AV block), CNS
    effectssedation and changes in sleep

11
Hydralazine
  • Use?
  • Mechanism of Action?
  • Reduces preload or afterload?
  • SE?
  • Vasodilator, severe HTN, CHF
  • Increased cGMP ? smooth muscle relaxation.
    Arterioles gt veins.
  • AFTERLOAD (Vasodilator!)
  • Nausea, Headache, Lupus-like syndrome, reflex
    tachycardia (dont use in agina or CAD!), angina,
    salt retention
  • Use with beta blocker to avoid tachycardia and
    with a diuretic to avoid salt retention

12
Minoxidil
  • Use?
  • Mechanism of Action?
  • SE?
  • Vasodilator, HTN
  • K channel opener, hyperpolarizes smooth muscle
    cells
  • HAIRY MONSTER, pericardial effusion, reflex
    tachycardia, angina, salt retention
  • Use with beta blocker to avoid tachycardia and
    with a diuretic to avoid salt retention

13
Captopril
  • Use?
  • Other Examples?
  • SE?
  • ACE Inhibitor, HTN
  • Enalapril, Fosinopril
  • Hyper-K, cough, angioedema, taste changes,
    hypotension, fetal renal damage, rash, increased
    renin

14
Hexamethonium
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Severe orthostatic hypotension, blurry vision,
    constipation, sexual dysfxn ?

15
Verapamil
  • Use?
  • MOA?
  • More cardiac or smooth muscle effects?
  • SE?
  • Toxicity?
  • Calcium Channel Blocker, HTN, angina,
    arrhythmias, Raynauds
  • Blocks Voltage Dependant L-type Ca channels,
    decreasing contractility
  • Cardiac, but also vasodilator
  • Dizziness, flushing, constipation, AV block,
    Nausea
  • Cardiac depression, peripheral edema, flushing,
    dizziness, constipation

16
HOW DO YOU TREAT MALIGNANT HYPERTENSION???
  • Three drugs in alphabetical order
  • 1 DIAZOXIDE
  • MOA?
  • K channel openerhyperpolarizes smooth muscle
  • 2 Fenoldopam
  • MOA?
  • Dopamine1 Receptor Agonist relaxes vascular
    smooth muscle
  • 3 Nitroprusside
  • MOA?
  • Increased cGMP via direct NO release
  • SE?
  • CYANIDE POISONING!!!

17
Nitroprusside
  • Use?
  • SE?
  • Vasodilator, HTN
  • Cyanide Poisoning (Releases CN!)

18
WHICH TWO DRUGS ARE THE HYPERTENSION IN PREGNANCY
SUPERSTAR MEDS?(Which are ok to use in
Pregnancy?)
  • HYDRALAZINE METHYLDOPA

This, on the other hand is NOT safe in
pregnancy. ?
19
Diltiazem
  • Use?
  • MOA?
  • More cardiac or smooth muscle effects?
  • SE?
  • Toxicity?
  • Calcium Channel Blocker, HTN, angina,
    arrhythmias, Raynauds
  • Blocks Voltage Dependant L-type Ca channels,
    decreasing contractility
  • Somewhere in the middle
  • Dizziness, flushing, constipation, AV block,
    Nausea
  • Cardiac depression, peripheral edema, flushing,
    dizziness, constipation

20
Losartan
  • Use?
  • Good alternative to what?
  • SE?
  • Angiotensin II Receptor Blocker, HTN
  • ACE Inhibitors
  • Fetal renal toxicity, Hyper-K

21
Nifedipine
  • Use?
  • MOA?
  • More Cardiac or Smooth Muscle Effects?
  • SE?
  • Toxicity?
  • Calcium Channel Blocker, HTN, angina, Raynauds
  • Blocks Voltage Dependant L-type Ca channels,
    decreasing contractility
  • Smooth musclevasodilator
  • Dizziness, flushing
  • Cardiac depression, peripheral edema, flushing,
    dizziness, constipation

22
CHOLESTEROL DRUGS
  • Which is best for decreased triglycerides?
  • Fibrates
  • Examples?
  • Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
  • Which are best for decreasing LDL?
  • Statins
  • MOA?
  • HMG CoA reductase inhibitorsinhibit cholestrol
    precursor mevalonate
  • Which do patients hate taking because of GI
    disturbances?
  • Bile Acid Resins Cholestyramine Colestipol
  • What are two other possible drugs you could use?
  • Cholesterol Absorption Blockers (Ezetimibe) and
    Niacin

23
Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I
Class II
Class III
Class IV
24
Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide
Class II
Class III
Class IV
25
Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide
Class II Beta Adrenergic Receptor AntagonistsPropranolol, Metoprolol
Class III
Class IV
26
Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide
Class II Beta Adrenergic Receptor Antagonists Propranolol, Metoprolol
Class III Prolong action potential with little effect on phase 0 depolarization, mostly via blocking the K repolarizing current Amiodarone, Sotalol, Ibutilide
Class IV
27
Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide
Class II Beta Adrenergic Receptor Antagonists Propranolol, Metoprolol
Class III Prolong action potential with little effect on phase 0 depolarization, mostly via blocking the K repolarizing current Amiodarone, Sotalol, Ibutilide
Class IV Block slow L-type Calcium Channels Verapamil, Diltiazem
28
Class I Drugs Broken up by degree of Na channel
blockade and effect on AP duration
  • CLASS IA Drugs
  • MOA?
  • Moderate blockade of Na channels raise AP
    threshold and slow AP upstroke. Also depress
    slope of phase 4 depolarization.
  • Uses?
  • Ectopic foci and reentrant rhythms
  • Atrial AND Ventricular Arrhythmias
  • Examples?
  • Quinidine, Amiodarone, Procainamide, Disopyramide
  • SE
  • Quinidine
  • Cinconchism HA, tinnitus, thrombocytopenia
  • Increase AP duration, increased effective
    refractory period, increase QT interval
    (increased risk of what?)
  • Torsades de points
  • Procainamide
  • Reversible SLE-like syndrome

29
Class I Drugs Broken up by degree of Na channel
blockade and effect on AP duration
  • CLASS IB Drugs
  • MOA?
  • Bold Na channels, but unlike IAs shorten
    duration of AP and refractory period
  • Uses?
  • Preferentially act on diseased tissue ischemic
    or depolarized Purkinje/ventricular tissue.
  • Great post-MI and for dig-induced arrhythmias
  • Examples?
  • Lidocaine, Mexiletine, Tocainide, Phenytoin?
  • SE
  • CNS depression/stim and cardiovasc depression

30
Class I Drugs Broken up by degree of Na channel
blockade and effect on AP duration
  • CLASS IC Drugs
  • MOA?
  • Most potent sodium channel blockers! Decrease
    upstroke of AP and conduction velocity
    everywhere!
  • No change in AP duration
  • Uses?
  • Vtachs that progress to VF and intractable SVT
  • LAST RESORT FOR REFRACTORY TACHYARRHYTHMIAS
  • Examples?
  • Flecanide, Encainide, Propafenone
  • SE
  • Proarrhythmic, esp post MI avoid in those with
    heart disease?increased mortality!
  • Prolonged refractory period in AV node.

31
Class II Drugs
  • MOA?
  • Beta blockers decreased cAMP and Ca currents.
    Decrease slope of phase 4 depolarization. AV
    node very sensitive.
  • Uses?
  • Abnormal pacemakers, Vtach, SVT, slow ventricular
    rate in a-fib or a-flutter
  • Examples?
  • Propranolol, Esmolol, Metoprolol, Atenolol,
    Timolol
  • Which one is super short acting?
  • ESMOLOL
  • SE
  • Impotence ?, asthma exacerbation, bradycardia, AV
    block, CHF,sedation, sleep changes
  • Why use with caution in diabetics?
  • Mask effects of hypoglycemia
  • Metoprolol
  • Dyslipidemia

32
Class III Drugs
  • MOA?
  • Potassium Channel Blockers increase AP duration
  • Uses?
  • used when other drugs fail
  • Examples?
  • Sotalol, Ibutilide, Bretylium, Amiodarone
  • Which is good for Wolf-Parkinson-White?
  • Amiodarone
  • SE
  • Sotalol
  • Increased QT Intervalwhy is this bad?
  • Increased risk of torsades de points
  • Excessive beta block
  • Ibutilide
  • Torsades
  • Bretylium
  • Arrhythmias, hypotension
  • Amiodarone
  • Pulm fibrosis, corneal deposits, Hepatotoxicity,
    photodermatitis, Neuro SE, constipation,
    bradycardia, heart block, hypothyroid,
    hyperthyroid

33
Class IV Drugs
  • MOA?
  • Calcium Channel Blockers AV node decreased
    conduction.
  • Uses?
  • Especially good for?
  • SVTs
  • Examples?
  • Verapamil and Diltiazem for Anti-arrhythmics
  • SE
  • Constipation, flushing, edema, CV effects,
    torsades

34
Adenosine
  • MOA
  • Increased K efflux hyperpolarization.
  • Drug of choice for which conditions?
  • AV nodal arrhythmias.
  • Short or long acting?
  • Very short (15 Seconds)
  • Toxicity
  • Flushing, Hypotension, Chest pain

35
Potassium
  • MOA
  • Decreases ectopic pacers in hypokalemia
  • Drug of choice for which conditions?
  • Dig toxicity

36
Magnesium
  • Drug of choice for which conditions?
  • Torsades and dig toxicity
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